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Sudden and unexpected deaths due to non-traumatic abdominal disorders: A forensic perspective. J Forensic Leg Med 2022; 89:102355. [DOI: 10.1016/j.jflm.2022.102355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/08/2022] [Accepted: 04/23/2022] [Indexed: 12/22/2022]
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Sengupta M, Dasgupta S, Basu K, Mukherjee S, Sarkar S, Chowdhury AR, Pandey R, Bandopadhyay M. A tale of tripartite: An experience from a tertiary care center of Eastern India. INDIAN J PATHOL MICR 2021; 64:497-503. [PMID: 34341260 DOI: 10.4103/ijpm.ijpm_445_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Crescentic glomerulonephritis (Cr GN) is pattern of glomerular injury resulting from wide range of diseases sharing a common pathogenesis. Objectives The objective of our study was to analyze the clinicopathological spectrum and outcome of Cr GN with special reference to its immunopathological subtypes using a panel of immunofluorescence stains. Materials and Methods Native renal biopsies with crescentic pattern of injury were included. Detailed Clinical and laboratory variables were analyzed along with the treatment protocol and renal outcome, wherever available. Renal biopsy slides were evaluated for various glomerular and extraglomerular features. Both qualitative and quantitative data were analyzed. Results A total of 57 cases of Cr GN were included; majority (47.36%) of cases were pauci-immune in nature. Among clinical features, ranges of proteinuria and creatinine level were significantly different between subgroups. The various light microscopic parameters, including proportion of cellular crescents and capillary wall necrosis were different. Presence of arteriolar changes also showed association with unfavorable outcome. Three unusual associations, including IgA nephropathy, membranous glomerulonephritis and Hepatitis B infection were detected. Adequate follow-up information was available in 35 of the patients. Of these, 14 were dialysis-dependent at the last follow-up. Conclusions Type III Cr GN (pauci-immune Cr GN) was the commonest cause of Cr GN in our population. Adult patients required renal replacement therapy more frequently than pediatric cases those are chiefly infection associated. Critical appraisal of clinical, histopathological and immunofluorescence finding help to identify individual subtypes as treatment and outcome varies accordingly.
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Affiliation(s)
- Moumita Sengupta
- Department of Pathology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Saugat Dasgupta
- Department of Nephrology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Keya Basu
- Department of Pathology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Sriranjan Mukherjee
- Department of Pathology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Sucharita Sarkar
- Department of Pathology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | | | - Rajendra Pandey
- Department of Nephrology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
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Shibata Y, Fukuoka K, Yokota R, Lee H, Sayo H, Ikegaya N, Mori K, Yamamoto J, Isomura A, Nagahama K, Shimoyamada H, Kawakami T, Komagata Y, Kaname S. Nephrotic syndrome due to minimal-change disease superimposed on anti-glomerular basement membrane antibody positive glomerulonephritis; a case report. BMC Nephrol 2020; 21:283. [PMID: 32680573 PMCID: PMC7368767 DOI: 10.1186/s12882-020-01947-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/12/2020] [Indexed: 11/29/2022] Open
Abstract
Background The prognosis for renal function in anti-GBM glomerulonephritis (anti-GBM GN) is extremely poor, and when renal impairment progresses severely, it is difficult to expect improvement. In addition, it is also known that once the disease activity can be controlled by aggressive treatment, its recurrence is rare. We experienced an anti-GBM GN that improved from severe renal dysfunction and relapsed. A possible cause was the superimpose of nephrotic syndrome due to minimal change disease (MCD). Case presentation A 30-year-old man was admitted to our hospital because of general malaise, fever, oliguria and renal dysfunction. The patient’s laboratory data showed serum creatinine as high as 6.6 mg/dl, and severe inflammation (C-reactive protein 20.6 mg/dl). Anti-glomerular basement membrane antibody (anti-GBM Ab) was detected in his serum, which led to the diagnosis of anti-GBM GN. Treatment was initiated with high-dose glucocorticoid (GC) and plasma exchange therapy (PE), and the patient’s renal function and oliguria improved rapidly and he was discharged 40 days after admission. Renal biopsy findings showed cellular crescents associated with linear IgG depositions along the glomerular tufts compatible with anti-GBM GN, but only about one-third of the glomeruli was involved, suggesting that it still remains an early stage of the disease. However, 2 months after discharge, he had a relapse and was readmitted due to severe proteinuria with positive anti-GBM Ab. On the second admission, after high-dose GC and PE combined with intravenous cyclophosphamide, and remission was achieved. Despite the relatively minor renal biopsy findings, the patient showed rapid renal dysfunction and relatively rapid improvement with our treatment. Electron microscopy of the renal biopsy tissue showed significant foot process effacement on podocytes in the apparently normal glomeruli, without electron dense deposits. Conclusion On the basis of clinical course and renal pathology, it is suggested that the present case was a rare complication of an early stage of anti-GBM GN and minimal change nephrotic syndrome. Although the simultaneous development of anti-GBM GN and MCD with anti-GBM antibody is unclear, it might have been precipitated by influenza infection or some unknown factor.
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Affiliation(s)
- Yuko Shibata
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, 6-20-2, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Kazuhito Fukuoka
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, 6-20-2, Mitaka-shi, Tokyo, 181-8611, Japan.
| | - Riyo Yokota
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, 6-20-2, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Heryon Lee
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, 6-20-2, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Hikaru Sayo
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, 6-20-2, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Noriko Ikegaya
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, 6-20-2, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Kiyotaka Mori
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, 6-20-2, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Jin Yamamoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, 6-20-2, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Aya Isomura
- Department of Pathology, Kyorin University Hospital, Tokyo, Japan
| | | | | | - Takahisa Kawakami
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, 6-20-2, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Yoshinori Komagata
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, 6-20-2, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Shinya Kaname
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, 6-20-2, Mitaka-shi, Tokyo, 181-8611, Japan
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McCall AS, Bhave G, Pedchenko V, Hess J, Free M, Little DJ, Baker TP, Pendergraft WF, Falk RJ, Olson SW, Hudson BG. Inhibitory Anti-Peroxidasin Antibodies in Pulmonary-Renal Syndromes. J Am Soc Nephrol 2018; 29:2619-2625. [PMID: 30279272 PMCID: PMC6218858 DOI: 10.1681/asn.2018050519] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/04/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Goodpasture syndrome (GP) is a pulmonary-renal syndrome characterized by autoantibodies directed against the NC1 domains of collagen IV in the glomerular and alveolar basement membranes. Exposure of the cryptic epitope is thought to occur via disruption of sulfilimine crosslinks in the NC1 domain that are formed by peroxidasin-dependent production of hypobromous acid. Peroxidasin, a heme peroxidase, has significant structural overlap with myeloperoxidase (MPO), and MPO-ANCA is present both before and at GP diagnosis in some patients. We determined whether autoantibodies directed against peroxidasin are also detected in GP. METHODS We used ELISA and competitive binding assays to assess the presence and specificity of autoantibodies in serum from patients with GP and healthy controls. Peroxidasin activity was fluorometrically measured in the presence of partially purified IgG from patients or controls. Clinical disease severity was gauged by Birmingham Vasculitis Activity Score. RESULTS We detected anti-peroxidasin autoantibodies in the serum of patients with GP before and at clinical presentation. Enriched anti-peroxidasin antibodies inhibited peroxidasin-mediated hypobromous acid production in vitro. The anti-peroxidasin antibodies recognized peroxidasin but not soluble MPO. However, these antibodies did crossreact with MPO coated on the polystyrene plates used for ELISAs. Finally, peroxidasin-specific antibodies were also found in serum from patients with anti-MPO vasculitis and were associated with significantly more active clinical disease. CONCLUSIONS Anti-peroxidasin antibodies, which would previously have been mischaracterized, are associated with pulmonary-renal syndromes, both before and during active disease, and may be involved in disease activity and pathogenesis in some patients.
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Affiliation(s)
- A Scott McCall
- Department of Nephrology and Hypertension,
- Center for Matrix Biology
| | - Gautam Bhave
- Department of Nephrology and Hypertension
- Center for Matrix Biology
- Department of Cell and Developmental Biology, Vanderbilt University, Nashville, Tennessee
| | - Vadim Pedchenko
- Department of Nephrology and Hypertension
- Center for Matrix Biology
| | - Jacob Hess
- University of North Carolina Kidney Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and
| | - Meghan Free
- University of North Carolina Kidney Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and
| | - Dustin J Little
- Department of Nephrology, Walter Reed Army Medical Center, Bethesda, Maryland
| | - Thomas P Baker
- Department of Nephrology, Walter Reed Army Medical Center, Bethesda, Maryland
| | - William F Pendergraft
- University of North Carolina Kidney Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and
| | - Ronald J Falk
- University of North Carolina Kidney Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and
| | - Stephen W Olson
- Department of Nephrology, Walter Reed Army Medical Center, Bethesda, Maryland
| | - Billy G Hudson
- Department of Nephrology and Hypertension,
- Center for Matrix Biology
- Department of Cell and Developmental Biology, Vanderbilt University, Nashville, Tennessee
- Department of Cancer Biology
- Vanderbilt Ingram Cancer Center
- Department of Pathology, Microbiology, and Immunology, and
- Vanderbilt Institute of Chemical Biology, Vanderbilt University Medical Center, Nashville, Tennessee
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Crescentic glomerulonephritis with dual positive anti-GBM and C-ANCA/PR3 antibodies. Clin Nephrol Case Stud 2016; 4:5-10. [PMID: 29043135 PMCID: PMC5438001 DOI: 10.5414/cncs108666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 11/17/2015] [Indexed: 11/26/2022] Open
Abstract
Antiglomerular basement membrane (anti-GBM) antibodies are more often accompanied by myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) than by proteinase 3 antineutrophil cytoplasmic antibody (PR3-ANCA). Both disease processes can affect the kidneys and/or the lungs. Patients with dual positive disease may have an atypical presentation which may delay diagnosis and treatment. Here we report a case of crescentic glomerulonephritis associated with positive PR3-ANCA and anti-GBM antibodies who underwent both lung and kidney biopsies.
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6
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Chen S, Tang Z, Xiang H, Li X, Chen H, Zhang H, Hu W, Zeng C, Liu Z. Etiology and Outcome of Crescentic Glomerulonephritis From a Single Center in China: A 10-Year Review. Am J Kidney Dis 2016; 67:376-83. [DOI: 10.1053/j.ajkd.2015.07.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 07/30/2015] [Indexed: 11/11/2022]
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7
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Alchi B, Griffiths M, Sivalingam M, Jayne D, Farrington K. Predictors of renal and patient outcomes in anti-GBM disease: clinicopathologic analysis of a two-centre cohort. Nephrol Dial Transplant 2015; 30:814-21. [DOI: 10.1093/ndt/gfu399] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 12/02/2014] [Indexed: 11/13/2022] Open
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8
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Validation of a histopathologic classification scheme for antineutrophil cytoplasmic antibody–associated glomerulonephritis. Hum Pathol 2014; 45:1423-9. [DOI: 10.1016/j.humpath.2014.02.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 02/14/2014] [Accepted: 02/21/2014] [Indexed: 11/17/2022]
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9
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Batal I, Reyes DB, Popham S, Bijol V. Nodular glomerulosclerosis with anti-glomerular basement membrane-like glomerulonephritis; a distinct pattern of kidney injury observed in smokers. Clin Kidney J 2014; 7:361-366. [PMID: 25349695 PMCID: PMC4208785 DOI: 10.1093/ckj/sfu064] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 05/29/2014] [Indexed: 11/21/2022] Open
Abstract
Background Cigarette smoking has recently been recognized as a risk factor for developing nodular glomerulosclerosis and has also been frequently encountered in patients with anti-glomerular basement membrane (anti-GBM) disease. However, the concurrent presence of both patterns of glomerular injury has not been previously reported. Material and methods In this article, we describe three patients with non-diabetic nodular glomerulosclerosis, anti-GBM-like glomerulonephritis (GN) and a history of heavy smoking. Results Our cohort included three patients, of which two were men (53 and 77 years old) and one a 28-year-old woman. None of the patients had a history of diabetes mellitus but all of them were heavy smokers who presented with renal insufficiency and proteinuria. Nodular glomerulosclerosis and occasional small, non-circumferential crescents in different stages of development were found on kidney biopsy. Immunofluorescence microscopy studies showed intense linear IgG staining along the glomerular basement membranes in the absence of granular immune-type deposits. Electron microscopy evaluation revealed prominent endothelial cell injury without detectable electron-dense deposits. One patient was dialysis-dependent a few months post-biopsy while the other two patients maintained their kidney function 18 and 24 months post-biopsy but without a significant improvement of serum creatinine. Conclusions The combination of nodular glomerulosclerosis and anti-GBM-like GN appears to be a distinct pattern of injury observed in a small subset of heavy smokers. Although this pattern of glomerular injury might be less aggressive than the typical anti-GBM GN, it does not appear to carry a favorable prognosis.
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Affiliation(s)
- Ibrahim Batal
- Department of Pathology , Brigham and Women's Hospital and Harvard Medical School , Boston, MA , USA
| | - Daisy B Reyes
- Department of Nephrology , Renal Hypertension Center , Hudson, FL , USA
| | - Sandy Popham
- Department of Nephrology , Duluth Kidney Services , Duluth, MN , USA
| | - Vanesa Bijol
- Department of Pathology , Brigham and Women's Hospital and Harvard Medical School , Boston, MA , USA
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10
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Lutheran/basal cell adhesion molecule accelerates progression of crescentic glomerulonephritis in mice. Kidney Int 2014; 85:1123-36. [PMID: 24429403 PMCID: PMC4008878 DOI: 10.1038/ki.2013.522] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 10/17/2013] [Accepted: 10/24/2013] [Indexed: 12/14/2022]
Abstract
Migration of circulating leukocytes from the vasculature into the surrounding tissue is an important component of the inflammatory response. Among the cell surface molecules identified as contributing to leukocyte extravasation is VCAM-1, expressed on activated vascular endothelium, which participates in all stages of leukocyte–endothelial interaction by binding to leukocyte surface expressed integrin VLA-4. However, not all VLA-4-mediated events can be linked to VCAM-1. A novel interaction between VLA-4 and endothelial Lutheran (Lu) blood group antigens and basal cell adhesion molecule (BCAM) proteins has been recently shown, suggesting that Lu/BCAM may have a role in leukocyte recruitments in inflamed tissues. Here, we assessed the participation of Lu/BCAM in the immunopathogenesis of crescentic glomerulonephritis. High expression of Lu/BCAM in glomeruli of mice with rapidly progressive glomerulonephritis suggests a potential role for the local expression of Lu/BCAM in nephritogenic recruitment of leukocytes. Genetic deficiency of Lu/BCAM attenuated glomerular accumulation of T cells and macrophages, crescent formation, and proteinuria, correlating with reduced fibrin and platelet deposition in glomeruli. Furthermore, we found a pro-adhesive interaction between human monocyte α4β1 integrin and Lu/BCAM proteins. Thus, Lu/BCAM may have a critical role in facilitating the accumulation of monocytes and macrophages, thereby exacerbating renal injury.
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11
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Syeda UA, Singer NG, Magrey M. Anti-glomerular basement membrane antibody disease treated with rituximab: A case-based review. Semin Arthritis Rheum 2013; 42:567-72. [DOI: 10.1016/j.semarthrit.2012.10.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 09/30/2012] [Accepted: 10/30/2012] [Indexed: 11/30/2022]
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12
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Bogdanović R, Minić P, Marković-Lipkovski J, Stajić N, Savić N, Rodić M. Pulmonary renal syndrome in a child with coexistence of anti-neutrophil cytoplasmic antibodies and anti-glomerular basement membrane disease: case report and literature review. BMC Nephrol 2013; 14:66. [PMID: 23517575 PMCID: PMC3640983 DOI: 10.1186/1471-2369-14-66] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 03/15/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Pulmonary renal syndrome (PRS), denoting the presence of diffuse alveolar hemorrhage and glomerulonephritis as manifestations of systemic autoimmune disease, is very rare in childhood. The coexistence of circulating anti-neutrophil cytoplasmic antibody (ANCA) and anti-glomerular basement membrane (GBM) disease in children affected by this syndrome is exceptional, with unfavorable outcome in five out of seven patients reported to date. We describe a child with PRS associated with both circulating anti-myeloperoxidase (anti-MPO) ANCA and anti-GBM disease on renal biopsy who was successfully treated with immunosuppressive therapy. CASE PRESENTATION A 10-year old girl presented with fever, fatigue, malaise, and pallor followed by hemoptysis and severe anemia. Diffuse alveolar hemorrhage was revealed on fiberoptic bronchoscopy. Renal findings consisted of microscopic hematuria, moderate proteinuria, and anti-GBM disease on renal biopsy. ANCA with anti-MPO specificity were present whereas anti-GBM antibodies were on borderline for positivity. Methyl-prednisolone pulses followed by prednisone led to cessation of hemoptysis, marked improvement of lung fuction, and normal finding on chest x-ray within 10 days. An immunosuppressive regimen was then given consisting of prednisone daily for 4 weeks with subsequent taper on alternate day, i.v. cyclophosphamide pulses monthly for 6 doses, followed by mycophenolate mofetil that resulted in normal lung function tests, hemoglobin concentration, and anti-MPO level within four subsequent weeks. During 10-months of follow-up she remained well, her blood pressure and renal function tests were normal, and proteinuria and hematuria gradually resolved. CONCLUSION We report a child with an exceptionally rare coexistence of circulating ANCA and anti-GBM disease manifesting as PRS in whom renal disease was not the prominent part of clinical presentation, contrary to other reported pediatric patients. A review of literature on disease with double positive antibodies is also presented. Evaluation of a patient with PRS should include testing for presence of different antibodies. An early diagnosis and rapid institution of aggressive immunosuppressive therapy can induce remission and preserve renal function. Renal prognosis depends on the extent of kidney injury at diagnosis and appropriate treatment.
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Affiliation(s)
- Radovan Bogdanović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Institute of Mother and Child Healthcare of Serbia “Dr Vukan Čupić”, 8 R Dakica Str, Belgrade, 11070, Serbia
| | - Predrag Minić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Institute of Mother and Child Healthcare of Serbia “Dr Vukan Čupić”, 8 R Dakica Str, Belgrade, 11070, Serbia
| | | | - Nataša Stajić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Institute of Mother and Child Healthcare of Serbia “Dr Vukan Čupić”, 8 R Dakica Str, Belgrade, 11070, Serbia
| | - Nataša Savić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Institute of Mother and Child Healthcare of Serbia “Dr Vukan Čupić”, 8 R Dakica Str, Belgrade, 11070, Serbia
| | - Milan Rodić
- Institute of Mother and Child Healthcare of Serbia “Dr Vukan Čupić”, 8 R Dakica Str, Belgrade, 11070, Serbia
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Hénique C, Fligny C, Tharaux PL. L22. Crescent formation: unraveling local mediators that break glomerular epithelial cell tolerance to immune injury. Presse Med 2013; 42:565-8. [PMID: 23474044 DOI: 10.1016/j.lpm.2013.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Carole Hénique
- Inserm, université Paris-Descartes, Sorbonne Paris Cité, Paris cardiovascular centre (PARCC), 56, rue Leblanc, 75015 Paris, France
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Flamant M, Bollee G, Henique C, Tharaux PL. Epidermal growth factor: a new therapeutic target in glomerular disease. Nephrol Dial Transplant 2012; 27:1297-304. [DOI: 10.1093/ndt/gfs030] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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15
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Surindran S, Ayalon R, Hasan N, Beck LH, Salant DJ, Barisoni L, Skolnik EY, Beara-Lasic L. Coexistence of ANCA-associated glomerulonephritis and anti-phospholipase A(2) receptor antibody-positive membranous nephropathy. Clin Kidney J 2012. [PMID: 22833809 PMCID: PMC3341840 DOI: 10.1093/ckj/sfr149] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Antibodies to myeloperoxidase (MPO) and proteinase 3 (PR3) have been demonstrated to mediate anti-neutrophil cytoplasmic antibody (ANCA)-associated disease. For membranous nephropathy, antibodies to the podocyte-expressed phospholipase A2 receptor (anti-PLA2R) are highly associated with disease activity and have been reported in at least 70% of patients with idiopathic membranous nephropathy (IMN). We present a case of a 56-year-old male with a 1 year history of hypertension, leg edema, and proteinuria, who presented with advanced renal failure and was found to have both ANCA-associated glomerulonephritis (GN) and IMN on kidney biopsy. Consistent with the idea that this is due to the chance occurrence of two independent diseases, we found both anti-MPO and anti-PLA2R antibodies in the patient's sera. Treatment with methylprednisolone, plasmapheresis, and cyclophosphamide resulted in improvement in kidney function and proteinuria, together with the simultaneous decrease in both autoantibodies. This is the first demonstration of two pathogenic antibodies giving rise to ANCA-associated GN and IMN in the same patient. It confirms the importance of classifying disease based upon the underlying mechanism, in addition to renal histopathology, to both optimize therapy and predict prognosis.
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Affiliation(s)
- Sheena Surindran
- Division of Nephrology, Department of Medicine, NYU Langone Medical Center, New York, NY, USA
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16
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Surindran S, Ayalon R, Hasan N, Beck LH, Salant DJ, Barisoni L, Skolnik EY, Beara-Lasic L. Coexistence of ANCA-associated glomerulonephritis and anti-phospholipase A(2) receptor antibody-positive membranous nephropathy. Clin Kidney J 2012; 5:162-165. [PMID: 22833809 DOI: 10.1093/ndtplus/sfr149] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 09/14/2011] [Indexed: 11/13/2022] Open
Abstract
Antibodies to myeloperoxidase (MPO) and proteinase 3 (PR3) have been demonstrated to mediate anti-neutrophil cytoplasmic antibody (ANCA)-associated disease. For membranous nephropathy, antibodies to the podocyte-expressed phospholipase A(2) receptor (anti-PLA(2)R) are highly associated with disease activity and have been reported in at least 70% of patients with idiopathic membranous nephropathy (IMN). We present a case of a 56-year-old male with a 1 year history of hypertension, leg edema, and proteinuria, who presented with advanced renal failure and was found to have both ANCA-associated glomerulonephritis (GN) and IMN on kidney biopsy. Consistent with the idea that this is due to the chance occurrence of two independent diseases, we found both anti-MPO and anti-PLA(2)R antibodies in the patient's sera. Treatment with methylprednisolone, plasmapheresis, and cyclophosphamide resulted in improvement in kidney function and proteinuria, together with the simultaneous decrease in both autoantibodies. This is the first demonstration of two pathogenic antibodies giving rise to ANCA-associated GN and IMN in the same patient. It confirms the importance of classifying disease based upon the underlying mechanism, in addition to renal histopathology, to both optimize therapy and predict prognosis.
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Affiliation(s)
- Sheena Surindran
- Division of Nephrology, Department of Medicine, NYU Langone Medical Center, New York, NY, USA
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Abstract
Crescentic glomerulonephritis (GN) in a renal biopsy is a widely accepted "critical diagnosis" in Anatomic Pathology practice. Prompt biopsy evaluation and notification of the referring physician is essential to facilitate rapid therapeutic intervention. The differential diagnostic categories of crescentic GN include pauci-immune GN, anti-glomerular basement membrane (GBM) nephritis and immune complex-mediated GN, distinguished from one another by immunofluorescence and electron microscopic study of the renal biopsy. Immune complex-mediated GN is characterized by abundant glomerular deposits and encompasses several diseases including but not limited to lupus nephritis, cryoglobulinemic GN and immunoglobulin A nephropathy. Pauci-immune GN, with paucity of deposits, correlates closely with antineutrophil cytoplasmic antibody disease due to the identifiable circulating pathogenic antineutrophil cytoplasmic antibody in most patients. Recent studies have identified other antibodies in pauci-immune GN and implicated infectious organisms in triggering autoimmunity in a susceptible host by molecular mimicry of host antigens. Anti-GBM nephritis is a rare but potentially life-threatening autoimmune disease with circulating antibodies against GBM epitopes in α3 chain of type IV collagen. It is characterized by a linear immunoglobulin G deposition along GBM on immunofluorescence microscopy. Environmental triggers including infections and solvent exposure seem to change the tertiary structure of the type IV collagen α345 hexamer in GBM, expose neoepitopes, and initiate autoimmunity. Even in light of advances in understanding of pathophysiology and serologic testing, renal biopsy remains the mainstay of diagnosis of crescentic GN.
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Crescentic Glomerulonephritis with Anti-GBM and p-ANCA Antibodies. Case Rep Nephrol 2012; 2012:132085. [PMID: 24527239 PMCID: PMC3914222 DOI: 10.1155/2012/132085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 02/01/2012] [Indexed: 12/03/2022] Open
Abstract
We are presenting a case of renal failure with anti-GBM and p-ANCA antibodies positive. Patients with dual antibodies are considered to be a vasculitis-variant of anti-GBM antibody nephritis. These patients may have atypical presentation and it may delay diagnosis and treatment. Recurrence rate is higher in these patients. We reviewed the literature of cases and studies on cresenteric glomerulonephritis with anti-GBM and p-ANCA positive patients. We recommend that patients suspected with pulmonary-renal syndrome should be checked for anti-GBM and p-ANCA antibodies, should undergo renal biopsy and should should have close long term follow up to watch for recurrence.
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Cui Z, Zhao J, Jia XY, Zhu SN, Jin QZ, Cheng XY, Zhao MH. Anti-glomerular basement membrane disease: outcomes of different therapeutic regimens in a large single-center Chinese cohort study. Medicine (Baltimore) 2011; 90:303-311. [PMID: 21862934 DOI: 10.1097/md.0b013e31822f6f68] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Anti-glomerular basement membrane (GBM) disease usually presents with rapidly progressive glomerulonephritis accompanied by pulmonary hemorrhage. The low incidence and fulminant course of disease preclude a large randomized controlled study to define the benefits of any given therapy. We conducted a retrospective survey of 221 consecutive patients seen from 1998 to 2008 in our hospital, and report here the patient and renal survival and the risk factors affecting the outcomes. Considering the similar clinical features of the patients, we could compare the effects of 3 different treatment regimens: 1) combination therapy of plasmapheresis and immunosuppression, 2) steroids and cytotoxic agents, and 3) steroids alone.The patient and renal survival rates were 72.7% and 25.0%, respectively, at 1 year after disease presentation. The serum level of anti-GBM antibodies (increased by 20 U/mL; hazard ratio [HR], 1.16; p = 0.009) and the presentation of positive antineutrophil cytoplasmic antibodies (ANCA) (HR, 2.18; p = 0.028) were independent predictors for patient death. The serum creatinine at presentation (doubling from 1.5 mg/dL; HR, 2.07; p < 0.001) was an independent predictor for renal failure.The combination therapy of plasmapheresis plus corticosteroids and cyclophosphamide had an overall beneficial effect on both patient survival (HR for patient mortality, 0.31; p = 0.001) and renal survival (HR for renal failure, 0.60; p = 0.032), particularly patient survival for those with Goodpasture syndrome (HR for patient mortality, 0.29; p = 0.004) and renal survival for those with anti-GBM nephritis with initial serum creatinine over 6.8 mg/dL (HR for renal failure, 0.52; p = 0.014). The treatment with corticosteroids plus cyclophosphamide was found not to improve the renal outcome of disease (p = 0.73). In conclusion, the combination therapy was preferred for patients with anti-GBM disease, especially those with pulmonary hemorrhage or severe renal damage. Early diagnosis was crucial to improving outcomes.
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Affiliation(s)
- Zhao Cui
- From Renal Division (ZC, JZ, XYJ, QZJ, XYC, MHZ), Department of Medicine, and Department of Biostatistics (SNZ), Peking University First Hospital, Beijing; Institute of Nephrology (ZC, JZ, XYJ, QZJ, XYC, MHZ), Peking University, Beijing; and Key Laboratory of Renal Disease (ZC, JZ, XYJ, QZJ, XYC, MHZ), Ministry of Health of China, Beijing
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Olson SW, Arbogast CB, Baker TP, Owshalimpur D, Oliver DK, Abbott KC, Yuan CM. Asymptomatic autoantibodies associate with future anti-glomerular basement membrane disease. J Am Soc Nephrol 2011; 22:1946-52. [PMID: 21868497 DOI: 10.1681/asn.2010090928] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The pathophysiology of anti-glomerular basement membrane (anti-GBM) disease before clinical presentation is unknown. The presence of anti-GBM, anti-proteinase 3 (PR3), and anti-myeloperoxidase (MPO) antibodies associate with the disease at the time of diagnosis, but little is known about the presence of these autoantibodies before diagnosis. We used serum samples from the Department of Defense Serum Repository to conduct a case-control study involving 30 patients diagnosed with anti-GBM disease and 30 healthy controls matched for the age, gender, race, and age of the serum samples. We analyzed a maximum of three samples from each subject: the most recent sample before diagnosis, the penultimate sample before diagnosis, and the oldest sample available; the average time between the most recent sample and diagnosis was 195 days (range, 4 to 1346 days). Elevated anti-GBM levels (≥3 U/ml) were present in four patients, all less than 1 year before diagnosis but in no controls. Detectable anti-GBM antibody levels (≥1 U/ml but <3 U/ml) in a single serum sample before diagnosis were more frequent in cases than controls (70% versus 17%, P < 0.001). Only study patients had detectable anti-GBM levels in multiple samples before diagnosis (50% versus 0%, P < 0.001). Almost all patients had detectable anti-PR3 and/or anti-MPO that preceded the onset of disease. Among patients with a clear antecedent antibody, anti-PR3 or anti-MPO always became detectable before the anti-GBM antibody. In summary, our data describe the subclinical formation of autoantibodies, which improves our understanding of the pathophysiology of anti-GBM disease.
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Affiliation(s)
- Stephen W Olson
- Department of Nephrology, Walter Reed Army Medical Center, Washington, DC 20307, USA.
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Etter C, Gaspert A, Regenass S, Wüthrich RP, Kistler T, Kain R, Cohen CD. Anti-hLAMP2-antibodies and dual positivity for anti-GBM and MPO-ANCA in a patient with relapsing pulmonary-renal syndrome. BMC Nephrol 2011; 12:26. [PMID: 21651778 PMCID: PMC3127995 DOI: 10.1186/1471-2369-12-26] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 06/08/2011] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Pulmonary-renal syndrome associated with anti-glomerular basement membrane (GBM) antibodies, also known as Goodpasture's syndrome, is a rare but acute and life-threatening condition. One third of patients presenting as anti-GBM antibody positive pulmonary-renal syndrome or rapidly progressive glomerulonephritis are also tested positive for anti-neutrophil cytoplasmic antibodies (ANCA). Whilst anti-GBM disease is considered a non-relapsing condition, the long-term course of double-positive patients is less predictable. CASE PRESENTATION We report a patient with such dual positivity, who presented with pulmonary hemorrhage, crescentic glomerulonephritis and membranous nephropathy. Plasmapheresis in combination with immunosuppressive therapy led to a rapid remission but the disease relapsed after two years. The serum of the patient was tested positive for antibodies to human lysosomal membrane protein 2 (hLAMP2), a novel autoantigen in patients with active small-vessel vasculitis (SVV). The anti-hLAMP2 antibody levels correlated positively with clinical disease activity in this patient. CONCLUSION We hypothesize that this antibody may indicate a clinical course similar to ANCA-associated vasculitis in double-positive patients. However, this needs to be confirmed on comprehensive patient cohorts.
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Affiliation(s)
- Christoph Etter
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Ariana Gaspert
- Department of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Stephan Regenass
- Division of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland
| | - Rudolf P Wüthrich
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Kistler
- Division of Nephrology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Renate Kain
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Clemens D Cohen
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
- Institute of Physiology, University of Zurich, Zurich, Switzerland
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Affiliation(s)
- Allan S Wiik
- Department of Autoimmunology, Statens Serum Institut, DK-2300 Copenhagen S, Denmark.
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Abstract
In 1923, Friedrich Wohlwill described two patients with a "microscopic form of periarteritis nodosa," which was distinct from the classical form. This disease, now known as microscopic polyangiitis (MPA), is a primary systemic vasculitis characterized by inflammation of the small-caliber blood vessels and the presence of circulating antineutrophil cytoplasmic antibodies. Typically, microscopic polyangiitis presents with glomerulonephritis and pulmonary capillaritis, although involvement of the skin, nerves, and gastrointestinal tract is not uncommon. Treatment of MPA generally requires use of a cytotoxic agent (such as cyclophosphamide) in addition to high-dose glucocorticoids. Recent research has focused on identifying alternate treatment strategies that minimize or eliminate exposure to cytotoxic agents. This article reviews the history, pathogenesis, clinical manifestations, and treatment of MPA.
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Zeidner JF, Ostrin EJ, Sydnor E, Fine D, Sperati CJ. The tissue's the issue. Am J Med 2010; 123:420-2. [PMID: 20399317 DOI: 10.1016/j.amjmed.2010.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 01/18/2010] [Accepted: 01/18/2010] [Indexed: 10/19/2022]
Affiliation(s)
- Joshua F Zeidner
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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Lindič J, Vizjak A, Ferluga D, Kovač D, Aleš A, Kveder R, Ponikvar R, Bren A. Clinical Outcome of Patients With Coexistent Antineutrophil Cytoplasmic Antibodies and Antibodies Against Glomerular Basement Membrane. Ther Apher Dial 2009; 13:278-81. [DOI: 10.1111/j.1744-9987.2009.00724.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jog NR, Dinnall JA, Gallucci S, Madaio MP, Caricchio R. Poly(ADP-ribose) polymerase-1 regulates the progression of autoimmune nephritis in males by inducing necrotic cell death and modulating inflammation. THE JOURNAL OF IMMUNOLOGY 2009; 182:7297-306. [PMID: 19454727 DOI: 10.4049/jimmunol.0803565] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Necrotic lesions and necrotic cell death characterize severe autoimmune nephritides, and contribute to local inflammation and to progression of the disease. Poly(ADP-ribose) polymerase-1 (PARP-1), a DNA repair enzyme, is involved in the induction of necrosis and is a key player in the acute and chronic inflammation. Therefore, we hypothesized that PARP-1 controls the severity of nephritis by mediating the induction of necrosis in the kidney. We used lupus and anti-glomerular basement membrane models of nephritis to determine the effects of PARP-1 on the inflammatory response in the kidney. We show in this study that PARP-1 is indeed activated during the course of glomerulonephritis. We also show that the absence of PARP-1 or its pharmacological inhibition results in milder nephritis, with lower blood urea nitrogen levels, reduced necrotic lesions, and higher survival rates. The relevance of PARP-1 showed a strong male sex specificity, and treatment of male mice with 17beta-estradiol prolonged their survival during the course of nephritis. PARP-1 also regulated TNF-alpha expression and up-regulation of adhesion molecules, further supporting a role of PARP-1 in the inflammatory process within the kidney. Our results demonstrate that PARP-1 activation and consequent necrotic cell death play an important role in the pathogenesis of male nephritis, and suggest that PARP-1 can be a novel therapeutic target in glomerulonephritis.
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Affiliation(s)
- Neelakshi R Jog
- Department of Medicine, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA 19104, USA
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